Facility Services Project Request Form
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3Facility Services Project Request Form
Please complete items 1 through 11 and submit the form by clicking the submit button below. Or, forward the completed form to
the Work Control Center, Maintenance and Materiel Building or Fax to Work Control Center at 715-346-2447.
Instructions:
A.
Complete Items 1 through 11.
B.
Special Requirements (under Item 1): Use this space to identify any special project requirements (e.g. temperatures to be
maintained at other that comfort values, humidity limitations, lighting levels, particular floor or wall finishes required etc.).
C.
Objective of Request (Item 2): Use this space to identify what objective is expected to be met as a result of this project (e.g.
conversion of an existing conference room into two private offices, provide a water cooling system for laboratory equipment, etc.).
D.
Desired Construction Completion Date (Item 8): A date should be provided for this request, unless the request is not for
construction activity. Facility Services will assign a default date if a construction completion date is not provided. “ASAP” is not
considered a valid completion date. If construction activity is not included in the request, write “N/A” in the space provided for the
date. If a date is provided, identify in the space provided events or criteria that are dependent on this date (e.g. work must be
completed before class begins in the fall semester, availability of funding expires with current fiscal year, space assigned to new
personnel who will start on January 1, 2015, etc.)
E.
Funding (Item 5): Use these spaces to identify funding source, customer estimate of project cost, and funding comments
such as expiration date if applicable, not-to-exceed amount if applicable, etc. Estimates for Campus delegated projects cannot
exceed $30,000 (including equipment and contingency) without additional approval.
1.
WORK LOCATION
Campus:
Building #:
Building Name:
Room No. (s):
Primary Use:*
*Identify any special requirement that must be incorporated into or accommodated by this project.
Account Number to be billed:
****No work can proceed without an account number.****
2.
DESCRIPTION OR SCOPE OF PROPOSED PROJECT:
3.
Project Contact:
Department Address:
E-mail Address:
Phone Number:
4.
Financial Responsibility:
Department Address:
E-mail Address:
Phone Number:
5.
Customer Estimate:
Funding Comments:
6.
Copy To:
Department Address:
Phone Number:
Copy To:
Department Address:
Phone Number:
7.
Facility Available for Construction:
From:
To:
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